CARDIOVASCULAR COMPLICATIONS IN PATIENTS AFTER CORONAVIRUS DISEASE-2019

The data of the modern literature describing the long-term consequences of infection of the body with SARSCoV-2 on the cardiovascular system in the framework of postcovid syndrome are analyzed. To date, postcovid syndrome refers to a condition in which symptoms continue to persist for more than 12 weeks from the moment of diagnosis of COVID-19. Various complaints of patients after undergoing a new coronavirus infection are described, the distinguishing feature of which is their versatility, where cardiovascular manifestations are assigned one of the leading roles. Postural orthostatic tachycardia syndrome, cardiac arrhythmia and conduction disorders are considered. The role of SARS-CoV-2 in the formation of de novo and decompensation of pre-existing cardiovascular diseases has been demonstrated. The possibility of developing heart failure in patients with COVID-19 as an outcome of inflammation of the heart muscle is shown. Particular attention is paid to the analysis of the incidence of myocarditis after 3 months or more from the diagnosis of COVID-19, as well as thrombotic complications, in the genesis of which the main role belongs to the formation of endothelial dysfunction resulting from the interaction of SARS-CoV-2 with vascular endothelial cells. The autoimmune component of the pathogenesis of damage to the cardiovascular system as a result of the formation of endothelial dysfunction in COVID-19 is also considered. The authors present a laboratory-instrumental algorithm for determining cardiovascular complications in people who have undergone COVID-19, including the determination of the N-terminal fragment of the brain natriuretic peptide B-type prohormone, the level of anticardial antibodies, electrocardiography, echocardiography, as well as magnetic resonance imaging of the heart with contrast. All rights reserved © Eco-Vector, 2022.

The Issue of Post-COVID Syndrome in Children and Adolescents: Approaches to Terminology, Pathogenesis, Clinical Manifestations, Diagnosis, and Treatment.

The article discusses the issues of terminology, epidemiology, etiopathogenesis, clinical manifestations, approaches to the diagnosis and treatment of post-covid syndrome (PCS). It has been shown that the incidence of PCS in people who had COVID-19 is 10-35%;there are no generally accepted approaches to defining the term PCS. Clinical manifestations of PCS include more than 50 symptoms that occur in both children and adults, regardless of their place of residence. The damage caused by metabolites of the systemic inflammatory response of the central nervous system with the formation of a syndrome of autonomic dysfunction, cognitive impairment, and affective disorders is of critical importance in the genesis of PCS. Antipsychotics, antidepressants, and benzodiazepine drugs are used in the correction of PCS. However, they have limitations, in particular - when used in children with comorbid disorders. The use of aminoacetic acid (glycine), which has a wide range of safety, anxiolytic, anti-inflammatory, and nootropic effects in the correction of PCS, can become an effective therapeutic strategy.Copyright © Team of Authors, 2022.

The Issue of Post-COVID Syndrome in Children and Adolescents: Approaches to Terminology, Pathogenesis, Clinical Manifestations, Diagnosis, and Treatment

The article discusses the issues of terminology, epidemiology, etiopathogenesis, clinical manifestations, approaches to the diagnosis and treatment of post-covid syndrome (PCS). It has been shown that the incidence of PCS in people who had COVID-19 is 10–35%;there are no generally accepted approaches to defining the term PCS. Clinical manifestations of PCS include more than 50 symptoms that occur in both children and adults, regardless of their place of residence. The damage caused by metabolites of the systemic inflammatory response of the central nervous system with the formation of a syndrome of autonomic dysfunction, cognitive impairment, and affective disorders is of critical importance in the genesis of PCS. Antipsychotics, antidepressants, and benzodiazepine drugs are used in the correction of PCS. However, they have limitations, in particular — when used in children with comorbid disorders. The use of aminoacetic acid (glycine), which has a wide range of safety, anxiolytic, anti-inflammatory, and nootropic effects in the correction of PCS, can become an effective therapeutic strategy. © Team of Authors, 2022.

Neurological Signs of Postcovid Syndrome.

The challenge of postcovid syndrome (PCS) is of great interest due to its wide distribution and variety of clinical signs. The main neurological signs of PCS are discussed. Data on the presumptive mechanisms forming PCS are presented. The potential for using the drug Mexidol to treat patients with PCS is addressed.

Neurological Aspects of the Sequelae of COVID-19 in Children.

It has now been established that neurological and neuropsychiatric disorders persist for prolonged periods in a significant proportion of adult patients who have had COVID-19, though there is much less information about the manifestations of post-COVID syndrome (PCS) in children and adolescents. This review presents data on the features of the course of PCS in young patients, and considers the options for treating these patients. The results of studies on the use of Cortexin for correcting cognitive and emotional disorders are analyzed.

Determination of the Prevalence of Postcovid Syndrome and Assessment of the Effectiveness of the Drug Cortexin in the Treatment of Neurological Disorders in Patients with Postcovid Syndrome. Results of the CORTEX Multicenter Clinical and Epidemiological Observational Program.

Objectives. To study the prevalence and clinical manifestations of postcovid syndrome (PCS) in out-patients and to assess the efficacy of treatment with the drug Cortexin at doses of 10 and 20 mg i.m. for 10 days. Materials and methods. A total of 979 patients with PCS from regions of the Russian Federation, Azerbaijan, Kyrgyzstan, and Kazakhstan were studied; mean age was 54.6 ± 4.5 years; duration of COVID-19 was from one month upwards. Investigations involved three visits. The first was on the day of consultation (assessment of complaints, analysis of scale indicators, prescription of drug Cortexin at a dose of 10 or 20 mg i.m. for 10 days). The second visit (telephone consultation) was on day 10-14. The third visit was on day 30 of out-patient treatment. Assessment of patients' status used an asthenia assessment scale (MFI-20), a brief mental state assessment scale (MMSE), the Schulte test, and the Subjective Treatment Quality Assessment Scale. Results. The proportion of patients with PCS was up to 30% of all neurological admissions. The commonest manifestations were: fatigue, general weakness, decreased memory and concentration of attention, vertigo, sleep impairment, irritability, and aggression; less frequent were breathlessness, pain, increased sweating, anosmia, hyposmia, dysgeusia, paresthesia, hair loss, degradation of vision, tachycardia, allergic reactions, menstrual cycle impairments, erectile dysfunction, panic attacks, suicidal ideation, depression and refusal to eat meat. Conclusions: No associations were found between clinical symptomatology and the severity of COVID-19, the volume of lung tissue affected, or different periods of postcovid syndrome. Cortexin was found to be effective at doses of 10 and 20 mg for correcting the cognitive and asthenic manifestations of PCS. Cortexin was found to have anti-anxiety, antidepressant, and anxiolytic effects, which were more marked at the 20-mg dose.

[Clinical aspects of the use of imidazopyridine derivatives in the treatment of sleep disorders associated with post-COVID syndrome]. / Klinicheskie aspekty primeneniya preparatov gruppy imidazopiridinov v terapii narushenii sna, assotsiirovannykh s postkovidnym sindromom.

In 2019, a pandemic caused by the SARS-CoV-2 virus began. The fight against COVID-19 required the introduction of a number of restrictive measures, in particular the introduction of quarantine for the population and isolation of the sick, which, along with the direct effect of the virus on the nervous system, led to a significant spread of sleep disorders. In this regard, questions have become relevant about the choice of drugs for the correction of sleep disorders, about which sleeping pills will be safe in conditions of acute illness and during the recovery period after COVID-19. The article discusses the prevalence and therapy of insomnia in patients with acute COVID-19 and in patients with postcovid syndrome. The pharmacological effects and safety of zolpidem, a non-benzodiazepine short-acting hypnotic drug belonging to the class of imidazopyridines, which is used in short courses for both acute and transient insomnia and chronic insomnia, are described. The data on the ability of zolpidem to improve memory after a night's sleep are given. The possibility of its use in acute COVID-19 and postcovid syndrome is being evaluated.

Clinical and immunological characteristics of the postcovid period in patients with moderate-severe COVID-19 who received therapy with the inclusion of an IL-6 receptor antagonist

Introduction. Significant progress in clinical research has led to a better understanding of the pathogenesis of COVID-19, contributing to its more effective therapy. The revealed key role of IL-6 in the development and intensification of the <<cytokine storm>>, which has received reliable pathophysiological and pharmacological justification, supports the use of therapeutic strategies aimed at IL-6 or its receptor. Nevertheless, the changes that occur in the immune system after COVID-19 are of interest for a better understanding of the mechanisms of the formation of postcovid syndrome in patients receiving therapy with the inclusion of IL-6 receptor antagonists, its pathogenesis and the search for targets for further therapeutic effects. The aim of the study - to study the clinical and immunological parameters of patients who underwent a moderate-severe variant of COVID-19 and received therapy with the inclusion of IL-6 receptor antagonist during treatment and 6 months after discharge/recovery. Material and methods. 30 hospitalized patients were examined with the diagnosis: COVID-19, moderate-severe form;complication: bilateral polysegmental pneumonia. The comparison group consisted of practically healthy donors (30 people). The dynamics of laboratory parameters (general clinical, biochemical and immunological) were evaluated against the background of therapy with IL-6 blockers at discharge, as well as 6 months after discharge from the hospital, in addition, the quality of life was assessed 6 months after the COVID-19. Results. Postcovid syndrome in patients who have undergone COVID-19 in a moderate-severe form manifests itself in a number of symptoms - decreased appetite, weakness, sleep disorders, depression, headache, shortness of breath, cough, tachycardia, dizziness. In addition, there is an exacerbation of chronic diseases that requires correction in planned therapy. 6 months after discharge from the hospital, there is an increase in CRP and fibrinogen levels, which most likely also reflects the deterioration of the course of concomitant pathology. There is an increase in the level of T-lymphocytes, as well as a decrease in the level of B-lymphocytes. Conclusion. Patients who had COVID-19 require dynamic follow-up. In patients with a moderate-severe form of COVID-19 who received complex therapy with the inclusion of monoclonal antibodies to IL-6 receptors, dexamethasone, antiviral therapy, anticoagulants, oxygen therapy, there are dysregulatory processes in the immune system that persist 6 months after recovery. Copyright © 2022 Meditsina Publishers. All rights reserved.

ENDOCRINE DISORDERS IN THE BACKGROUND OF COVID-19 AND POSTCOVID SYNDROME

The SARS-CoV-2 virus that caused the 2019 new coronavirus infection (COVID-19) pandemic has posed an unprecedented challenge to the global health system and scientific community. As of this literature review, the infection has claimed more than 6 million lives, and more than 500 million people worldwide have already been infected with SARS-CoV-2. In addition to the basic, pulmonary manifestations of the disease, as well as the severe, life-threatening complications of acute COVID-19, the long-term changes that occur in the postcovid period also affect other systems: endocrine, cardiovascular, nervous, and musculoskeletal. In this literature review, using data from current scientific publications obtained by searching <<covid-19 endocrine disorders>>, <<postcovid endocrine disorders>> and <<postcovid syndrome endocrine disorders>> in the MEDLINE (PubMed) database and <<endocrine pathology and covid-19>>, <<postcovid and endocrine pathology>> and <<postcovid syndrome and endocrine disorders>> in the e-Library database, we focused on describing and discussing the complications and consequences that SARS-CoV-2 infection can have on the endocrine glands, including the adrenals, thyroid, pituitary, gonads and pancreas. Copyright © 2022 Russian Association of Endocrinologists. All rights reserved.

Post-covid syndrome: psychoneurological disorders in focus

The outbreak of the novel coronavirus infection pandemic has spread all over the world millions of people have been recovered from it that makes necessary the research of their health status after the acute infection phase. The accumulated data about previous coronavirus epidemics showed their prolonged impacton the nervous system with the manifestation of mental and neurological symptoms. Specialists from different countries from the beginning of the pandemic have revealed typical symptoms in patients recovered from coronavirus infection with negative tests still complained on residual respiratory, gastroenterological and psychoneurological symptoms that manifested with asthenic, cognitive, dissomnic and affective disorders, anosmia and changes in taste preferences. No correlation between infection severity and symptoms set in the reconvalescence period has been found. Different countries have been used different terms to describe it like prolonged, long, chronic covid.The leading medical centers have made their impact in this problem analysis During the two recent years a big international research base, including the data from electronic medical histories has been accumulated concerning COVID 19 reconvalescents health status. WHO has presented the postcovid 19 syndrome work definition, in its structure psychoneurological symptoms such as asthenia, anxiety-depressive and cognitive disorders, insomnia play an important role. The healthcare provision for the patients with postcovid syndrome remains the issue needed further elaboration, the most promising treatment plan seems the combination of pharma-cotherapy with psychosocial interventions. Tofizopam as a drug with anxiolytic, secondary precognitive and aniastenic effects can be recommended for the postocovid syndrome psychoneurological symptoms. © 2022, Remedium Group Ltd. All rights reserved.

[Neurological disorders in the postcovid period]. / Nevrologicheskie narusheniya v postkovidnom periode.

The consequences of COVID-19 include a wide range of neurological, emotional and cognitive impairments. The pathogenesis of postcovid disorders is complex and has not been fully studied. The article discusses the pathogenesis and clinical manifestations of neuropostocoid. A hypothesis is formulated about the possible role of circumventricular organs in its formation. The main directions of treatment of patients with postcovid disorders are proposed.

Use of Karmolis® DROPS in Comprehensive Rehabilitation after COVID-19

Aim. To evaluate the efficacy and safety of the use of KARMOLIS® DROPS in the rehabilitation of patients after COVID-19 infection. Material and methods. The study included and completed observation of 40 medical staff aged 20 to 60 years who had suffered from COVID-19 in a moderate to severe form. The follow-up period was 21 days. The study participants were divided into two groups. The main group (20 people) received KARMOLIS® DROPS. The control group (20 people) treatment was carried out without the use of KARMOLIS® DROPS. The effectiveness was evaluated according to a set of clinical and functional indicators. Results and discussion. Against the background of taking KARMOLIS® DROPS, reliable positive dynamics of the subjective assessment of shortness of breath (MRC scale) and the subjective assessment of sleep quality (Vane A.M. scale) were recorded in the main group. Subjective efficacy of the studied KARMOLIS ® DROPS was noted by almost all patients who underwent treatment, which is probably due to improved sleep and well-being by reducing autonomic reactions. Taking into account the data obtained during the study, KARMOLIS® DROPS can be used in the recovery process after COVID-19 as a component of comprehensive rehabilitation. Conclusion. The safety of using the herbal medicine KARMOLIS® DROPS was confirmed by the absence of adverse events and cases of decompensation of concomitant diseases during the study. Patients' emotionally positive perception of the drug ensured its high compliance. © 2022 Rostovskii Gosudarstvennyi Meditsinskii Universitet. All rights reserved.

Correction of Mitochondrial Dysfunction in the Complex Rehabilitation of COVID-19 Patients.

Objective. To study the efficacy of courses of i.v., Cytoflavin in combination with the standard rehabilitation program for postcovid syndrome for correction of postcovid asthenia. Materials and methods. Follow-up investigations were carried out in 45 patients with postcovid syndrome at the second stage of rehabilitation. Patients were divided into two groups of comparable sex and age. The volume of lung damage was also similar in both groups, at 25-80%. The 24 patients making up the comparison group received standard postcovid rehabilitation: pulsed magnetotherapy, inhalation therapy, aeroionotherapy, infrared laser therapy, courses of aerobic training, rational psychotherapy, and successive drug therapy. The 21 patients of the study group additionally received intravenous Cytoflavin daily for 10 days. The dynamics of increases in scores on the Rehabilitation Routing Scale, the Hamilton Depression Rating Scale (HDRS), the Asthenic Status Scale, and the 6-minute walk test at admission and discharge were also monitored. Results and conclusions. Addition of courses of intravenous Cytoflavin to the complex rehabilitation program for postcovid syndrome significantly improved the general functional state of the body, decreased levels of depression and asthenization, and increased physical exercise tolerance.

STUDY OF LONG-TERM CLINICAL AND PATHOGENETIC EFFECTS OF FAVIPIRAVIR-BASED ANTI-VIRAL DRUG IN PATIENTS WITH METABOLIC SYNDROME IN POST-COVID PERIOD

The article presents modern scientific data on long-term clinical and pathogenetic effects of the antiviral drug Areplivir (Favipiravir) in patients with metabolic syndrome in the post-COVID period. The aim of the article is to study long-term cytokine-mediated (IL-6/sIL6r and LIF/sLIFr) pathogenetic effects of the favipiravir (Areplivir®) based drug on the incidence of complications in patients with metabolic syndrome in the post-COVID period. Material and methods. With the approval of the local ethics committee at the N.P. Ogarevs Mordovia State University (Protocol No. 5 dated May 17, 2020) “An open prospective comparative study of the Areplivir® (Favipiravir) drug effectiveness in reducing the risk of complications in the post-COVID period in patients with metabolic syndrome” in the Republic of Mordovia was carried out. The study included 190 metabolic syndrome patients who received the outpatient treatment for COVID-19 at Saransk polyclinics from February 2021 to March 2021. The case of COVID-19 was diagnosed in accordance with the current Temporary Guidelines for the prevention, diagnosis and treatment of the new coronavirus infection. Results. The analysis of the metabolic syndrome patients' follow-up within 1 year after undergoing COVID-19, revealed significant differences in the incidence of complications depending on the intake of the favipiravir based drug. The patients who were administrated with favipiravir at the early stage of infection, were characterized by lower serum levels of four members of the interleukin 6 family - IL-6 (IL-6, sIL6r and LIF, sLIFr) 10, 30 and 180 days after a clinical and laboratory recovery (p<0.001). The average statistical changes in the IL-6/sIL6r system of the group administrated with favipiravir, were 90%, and they were higher than in the group not administrated with antiviral drugs. In the group of the patients administrated with favipiravir, there was a significant (p<0.001) positive dynamic of the sLIFr indicator, while in the comparison group, there was an increase in this indicator. A protective effect of the early favipiravir use was characterized by a decrease in the frequency of cardiovascular complications, a 2.66-fold decrease in the risk of a stroke and the ACS in the post-COVID period. Conclusion. The areplivir therapy in the acute period of coronavirus infection made it possible to timely reduce the viral load. It helps to correct the pro-inflammatory vector of the immune response at the post-COVID stage and, accordingly, reduces the risk of progression of atherosclerosis, transient cerebrovascular accidents with a cognitive decline, an endothelial dysfunction, and can be considered a secondary prevention of life-threatening cardiovascular complications. © 2022 Volgograd State Medical University, Pyatigorsk Medical and Pharmaceutical Institute. All rights reserved.

[Neurological aspects of the consequences of COVID-19 in children]. / Nevrologicheskie aspekty posledstvii COVID-19 u detei.

To date, it is well established that neurological and neuropsychic disorders persist for a long time in a significant part of adult patients who have undergone COVID-19, despite the fact that there is much less information about the manifestations of postcovid syndrome (PCS) in children and adolescents. The review provides data on the features of the course of PCS in young patients, discusses the possibilities of treating such patients. The results of studies on the use of the drug Cortexin for the correction of cognitive and emotional disorders are analyzed.

[The use of neurotropic therapy in young patients with postcovid syndrome]. / Primenenie neirotropnoi terapii u molodykh patsientov s postkovidnym sindromom.

OBJECTIVE: The aim of the present study was to identify postcovid asthenic syndrome and cognitive disorders in young patients on an outpatient basis, and to evaluate the experience of using combined neurotropic therapy in this category of patients. MATERIAL AND METHODS: Included 87 young patients who underwent COVID-19 and applied for an outpatient appointment with a neurologist. All patients underwent a scale assessment of the severity of asthenia on the MFI-20 scale, cognitive functions - on the MMSE scale, the 5-word test and the Schulte test. The severity of the anxiety syndrome - according to the Spielberger Anxiety Scale. All patients in the study group were treated with a combination of Cortexin and Recognan, and a repeat study was conducted 4 weeks after treatment. RESULTS: The study revealed the predominance in the observation group of patients with a comorbid background, as well as pronounced anxiety disorders. After the complex treatment, there was a significant decrease in the indicators of common, physical, mental asthenia, as well as an increase in motivational activity, there was a decrease in situational anxiety, and to a lesser extent personal anxiety. According to cognitive tests, there was an improvement in indicators on the MMSE scale, direct reproduction of the 5-word test, significant changes in the evaluation of work efficiency when performing the Schulte test. CONCLUSION: It should be noted that the positive results of this study can be considered a decrease in the severity and severity of asthenia symptoms, a decrease in anxiety manifestations, and an improvement in cognitive functions against the background of complex neurotropic therapy with Cortexin and Recognan. Preference in this situation should be given to drugs with a multimodal mechanism of action, as well as creating optimal combinations of drugs that potentiate each other's action.

[Neurological manifestations of postcovid syndrome]. / Nevrologicheskie proyavleniya postkovidnogo sindroma.

The problem of postcovid syndrome (PCS) attracts great interest due to the wide prevalence and variety of clinical manifestations. The main neurological manifestations of PCS are considered. The information about the proposed mechanisms of the formation of PCS is given. The possibility of using the drug Mexidol for the treatment of patients with PCS is discussed.

Rehabilitation of post-COVID patients with chronic fatigue and cognitive disorders syndromes

Introduction. Almost all patients, who have experienced acute manifestations of COVID-19, regardless of the severity of the acute phase of the disease, are only at the beginning of a long way to recovery. According to experts, SARS-CoV-2 infection should affect almost 80% of the world's population, so all these patients to a greater or lesser extent will need a rehabilitation of certain manifestations of postcovid syndrome. Purpose: to study the effectiveness of rehabilitation program and the dynamics of cognitive impairment and manifestations of chronic fatigue syndrome in patients after coronavirus disease. Methods: The study design included 60 patients after SARS-Cov-2 infection. Among the examined patients there were 26 (43,3%) women and 34 (56,7%) men. An average age of the patients was 43,9 +/- 1,08 years. Patients were referred to the Department of Physical Rehabilitation after coronavirus disease with chronic fatigue and cognitive disorders syndromes. Accordingly, all patients, who participated in the study, were divided into two groups: group I - 28 patients with a general condition of moderate severity at the hospital stage and 32 patients - group II, with severe course of the disease and oxygen demand at the hospital stage. Depending on the duration of rehabilitation, two observation periods were used - on the 7th and 14th day of rehabilitation program. Results: It has been proven, that patients, who didn't need oxygen, were complaining about anosmia, cephalgia, cognitive impairment, increased anxiety and fatigue. Dysgeusia, dyssomnia, and depression were more common in patients, requiring oxygen therapy at the hospital stage. Rehabilitation program eliminated cognitive dysfunction, depression, cephalgia, drowsiness and dyssomnia on the 7th day in patients, who did not require oxygen therapy (p>0,05), and in patients, who needed oxygen therapy - on the 14th day of the rehabilitation program (p>0,05). However, 2 (6,3%) and 3 (9,4%) patients, who needed oxygen therapy, even after 14 days of rehabilitation had manifestations of minor recurrent headache and drowsiness. Conclusion: Thus, patients after coronavirus disease, who needed oxygen therapy at the hospital stage, need long-term rehabilitation program.

POSTCOVID SYNDROME - POLYMORPHISM OF DISORDERS IN A NEW CORONAVIRUS INFECTION

COVID-19, having not completed its epidemic development, gradually passes into the stage of prolonged diseases, which at the clinical level is designated as «postcovid syndrome». The symptomatology of these negative phenomena is quite diverse, covers the dysfunction of many organs and systems, and deserves the formulation of polymorphism of secondary and delayed complications. They are based on the consequences of the transferred acute phase of inflammation, systemic prolonged metabolic and structural disorders, including the studied genetic disorders. Possible causes of polymorphism of disorders and their manifestations in the postcovid period are considered. © 2021. All Rights Reserved.

COVID-19, postcovid syndrome and postvaccination complications at neurology outpatient clinic

This article describes a collection of patients who visited our neurology outpatient clinic between autumn 2020 and 2021 due to COVID-19, postcovid syndrome or neurological complications in possible relation to vaccination. It is a summary of individual patients’ cases;the author is aware of the statistically insignificant size and characteristics of this collection of patients. Amongst the patients treated for COVID-19, was identified a group of patients with a negative PCR test. In these cases, the diagnosis was determined based on a clinical review, epidemiological anamnesis and antibody testing. In case of continuation or aggravation of the COVID-19 symptoms, it was found beneficial to prescribe 20-60 mg of prednisone at the beginning of the second week of infection. Furthermore, this article describes the most frequent neurological postcovid complications and the effect of short-term pulse treatment by the prescription of 8 mg of methylprednisolone for 15 days. We also report a collection of patients with neurological complications in possible relation to vaccination against COVID-19. © 2021, Czech Medical Association J.E. Purkyne. All rights reserved.